Refractive Surgery

Refractive surgery has certainly come a long way since radial keratotomy (RK) in the 1970s. Incisional surgeries like RK were often unpredictable and unstable over time. Fortunately, RK has given way to a host of surgical options that are much more precise and stable, giving clearer vision and outstanding patient satisfaction. Let’s look at what refractive surgery can (and can’t) do today.

Better vision

Clearly, the biggest reason for choosing refractive surgery is improved unaided vision. While some patients have relatively mild problems with their eyesight, others experience major disturbances in their vision that makes functioning day to day almost impossible without the use of visual aids. Refractive surgery aims to permanently improve the clarity of your natural vision and reduce the need for visual aids like glasses and contact lenses. Nearsightedness is the most common vision issue that is treated in refractive surgery, but astigmatism and, to a more limited extent, farsightedness can be treated as well. However, successful surgery still may not completely eliminate the need for glasses or contact lenses. Also, the eyes are living tissue which changes over time. Certain changes in your vision are expected as we age, even after refractive surgery.

Freedom in activities

Wearing glasses or even contact lenses can interfere with some activities, like sports or working in challenging environments. Refractive surgery may make it possible to perform these activities without having to rely on visual aids.

More options for more needs

There are several ways vision can be improved with surgery today. Let’s look at the available procedures:

LASIK

LASIK surgery is the most common refractive procedure performed today and can be performed in one, very short session. LASIK is a form of laser vision correction, where an ultra-precise excimer laser is used to reshape the front window of the eye called the cornea. This is done after a different laser is used to create a “flap” in the cornea to allow the sensitive top layers to be moved out of the way during the corrective laser application. The flap is then placed back into position at the end of the procedure and heals quickly. This allows for nearly instant vision improvement and fast recovery. You should expect to spend around 30 minutes in the surgery suite, but the actual time it takes can be as little as 10 minutes – for both eyes! The remainder of the time will be spent preparing you and ensuring you are comfortable afterward. The entire process is carried out after anesthetic drops have been placed into your eyes, so you can rest assured you will feel absolutely no pain throughout.

However, if you are particularly anxious about the process, it may be possible to be given a sedative to help you relax.

LASIK works very well for low to moderate degrees of nearsightedness and astigmatism. Low degrees of farsightedness can also be corrected, but this is less commonly performed. Laser vision correction does not stop or correct the loss of focusing ability that occurs in everyone with age (presbyopia). Therefore, people that achieve excellent distance vision with laser vision correction will still lose their ability to see clearly up close with time.

Since this procedure works by removing tissue from the cornea, people that have a thin cornea or high prescription may not be good candidates for LASIK. Also, complications involving the flap are possible, including dislodgement, inflammation underneath the flap, and epithelial ingrowth. LASIK can also cause worsening of dry eye signs and symptoms that are usually temporary but can be permanent.

PRK

Another form of laser vision correction is PRK. Like LASIK, PRK uses an excimer laser to reshape the cornea. However, no flap is created with PRK. Instead, the very top layer of the cornea is removed, and the laser is applied directly to the exposed surface. A bandage contact lens is placed on the eye at the end of the procedure to help the surface heal – a process that takes a few days. Vision recovery takes longer than with LASIK, and eyedrops are needed for several weeks afterward. However, since no flap is created, several potential complications are eliminated. PRK may be a better option than LASIK for people with thinner corneas or dry eye issues. PRK is the original laser vision correction procedure and was FDA-approved in the United States in 1995.

SMILE

A newer form of laser vision correction is SMILE. This procedure uses the same type of laser that is used to make the flap in LASIK. However, instead of creating a flap, the laser is used to precisely carve a “lenticule” in the center of the cornea which is removed through a tiny laser-cut incision near the edge of the cornea. This causes the front curvature of the cornea to change just like in LASIK. SMILE achieves nearly instant vision improvement and fast recovery without the potential flap complications of LASIK. There is a lower risk of dry eye issues as well.

SMILE may be used to correct nearsightedness and some astigmatism. Not all refractive surgeons currently offer SMILE, and the cost is usually greater than LASIK or PRK.

ICL

For patients who might not be a good candidate for a corneal refractive procedure, the implantable collamer lens (ICL) may be an alternative. In this procedure, a small lens is implanted in the eye just behind the pupil and in front of the natural crystalline lens. Think of it like putting a special, very small contact lens inside the eye! Since this procedure does not alter the shape of the cornea, it maintains more natural optics. This may result in less nighttime glare than corneal procedures like LASIK. ICL is also the only refractive surgery that is reversible, as the lens can be removed.

This is an excellent option for people with high degrees of nearsightedness or a thin cornea. However, it is not currently available for farsighted correction. ICLs are placed in one eye at a time, with usually one to two weeks between surgeries. This outpatient procedure is performed by a surgeon who specializes in refractive and cataract surgery and generally takes less than ten minutes. ICL surgery generally costs more than corneal refractive procedures like LASIK and SMILE.

Cataract surgery and clear lens extraction

Most people are familiar with cataracts, where the crystalline lens inside the eye becomes cloudy. This is a natural consequence of aging and will affect nearly everyone sooner or later. When the cataract begins to cause significant vision difficulties, cataract surgery is performed. The cloudy crystalline lens is removed and replaced with a clear artificial lens, called an intraocular lens (IOL). Since the lens is being replaced, this is also a type of refractive surgery. Almost any amount of nearsightedness, farsightedness or astigmatism can be corrected with the appropriate IOL power and design. Plus, this procedure can do something that no other refractive surgery can – create multifocal optics. With a multifocal IOL, both distance vision and near vision (and in-between) are corrected. This can greatly reduce the need for reading glasses for those over age 45.

This type of surgery can be performed even before cataracts are present. Called a Clear Lens Extraction (CLE), this is a good refractive surgery option for those who have already lost significant focusing ability from presbyopia. Plus, patients having CLE would not have to deal with cataracts developing later. This is also a more expensive option, particularly if cataracts have not developed as CLE is not covered by medical insurance.

Follow-up care

Regardless of the type of refractive procedure you have, follow-up visits with your optometrist are critically important. We will monitor the healing process and measure the improvement in your vision to make sure things are on track. If a complication arises, early detection and management with your doctor will help ensure a successful outcome. And just because you have less need for vision correction after surgery does not mean than ongoing care is less important. For example, people who are nearsighted still have the same higher risk for developing glaucoma, retinal tears and other eye diseases even after the nearsightedness is corrected with refractive surgery.

Expert care from people you trust

With all of the options for vision correction available now, the choices can seem a bit overwhelming. We are here to help guide you along the best path for your unique circumstances. Our doctors have decades of experience and are experts in vision. We can help you decide which option is best, answer your questions, and coordinate care with the top refractive surgeons in the region. In addition, we will be with you throughout the postoperative period to help you achieve the best outcome.

Please schedule an appointment today so we can help you see your best!
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